care of patients with gynecologic problems. Lecture 2. Flashcards
(111 cards)
0
Q
What is endometriosis
A
The inner uterine tissue implantation outside the uterine cavity. The tissue typically appears on the ovaries and the cul-de-sac (posterior rectovaginal wall) and less commonly on the other pelvic organs and structures. A “chocolate” cyst is an area of endometriosis on an ovary
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Q
The most common gynecologic manifestations
A
Pain, vaginal discharge, and bleeding.
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Q
Endometriosis responds to what treatment
A
Cyclic hormonal stimulation
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Q
The most common symptom of endometriosis is what and it usually peaks just before when
A
Pain, menstrual flow
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Q
What are manifestations of endometriosis
A
Dyspareunia (painful sexual intercourse) painful defecation, low back ache, and infertility. G.I. disturbances such as nausea and diarrhea are also common.
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Q
What diagnostic study helps screen for ovarian cancer but maybe positive in women with what gynecologic condition.
A
Antigen CA – 125, endometriosis
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Q
What is used to differentiate pelvic masses that might be mistaken for endometriosis
A
Transvaginal ultrasound
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Q
What is collaborative care aimed at with a patient that has endometriosis
A
Reducing pain, restoring sexual function, alleviating anxiety related to the disease and the uncertainty of the diagnosis, educated patient about the disease and its treatment, alleviating fear related to the possibility of laparoscopy or open surgery, preventing self-esteem disturbance related to infertility
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Q
What are some nonsurgical management interventions for patients that have endometriosis
A
Menstrual cycle control using oral contraceptives or progestins. Continuous low-level heat using wearable heat packs may provide temporary pain relief. Laxation techniques, yoga, massage, and biofeedback made increase muscle tissue hypoxia and hypertonicity and relieve ischemia by increasing blood flow to the affected areas. Calcium and magnesium may also relieve muscle cramping for some patients
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Q
Surgical management of endometriosis for women who wants to remain fertile is procedure?
A
Laparoscopic removal of endometrial implants and adhesions. Surgeon May also use a laser to treat endometriosis by vaporizing adhesions and endometrial implants
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Q
Teach patients that temporary post operative pain from what gas that’s used in surgery and that occurs in what areas of the body
A
Carbon dioxide, shoulders and chest
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Q
What is dysfunctional uterine bleeding
A
Excessive and frequently bleeding more than every 21 days. It is a diagnosis of exclusion, made after ruling out anatomic or systemic conditions such as drug therapy or disease. DUB occurs most often at the beginning or end of a woman’s reproductive years when ovulation is becoming established or when it is becoming a irregular at or after menopause
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Q
What is menses
A
The sloughing of the endometrial lining
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Q
Dysfunctional uterine bleeding occurs because of what? And that caused decreased levels of what hormone production.
A
Hormonal imbalance. Generally, it happens when the ovaries fail to ovulate. Progesterone
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Q
How does a decrease in progesterone affect dysfunctional uterine bleeding
A
Progesterone is needed to mature the uterine lining and prevent overgrowth. Without progesterone, prolonged estrogen stimulation causes the endometrium to go past it’s hormonal support, causing disordered shedding of uterine lining
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Q
Most cases of DUB are classified into two types. what are they and what is most common
A
Anovulatory DUB ( most common) and ovulatory DUB.
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Q
What are Leiomyomas
A
Fibroids
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Q
What is the treatment of choice for women with anovulatory DUB
A
Hormone manipulation. The drugs used depend on the severity of bleeding and age of the patient. Progestin or a combination, therapy, estrogen and progestin, is indicated when bleeding is heavy and acute. For nonemergent bleeding, contraceptives provide the progestin needed to stabilize the endometrial lining.
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Q
What is endometrial ablation and what is its purpose
A
Removal of the build up uterine lining and it stops the blood flow to fibroids that are causing excessive bleeding
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Q
What is a Fibroadenoma
A
Is a mass of connective tissue that is attached to the surrounding breast tissue. Most common benign lesion
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Q
What age group does Fibroadenomas normally occur with
A
During teenage years into the 30’s (most commonly)
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Q
What is fibrocystic breast condition
A
Fibrocystic changes of the breast include a range of changes involving the lobules, ducts, and stromal tissues of the breast. Because of these changes affect at least half of women over the lifespan, they are referred to as fibrocystic breast condition rather than fibrocystic disease.
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Q
Fibrocystic breast condition occurs in what type of women and between what years of age and is caused by what hormonal imbalances
A
Premenopausal, between 20 and 50 years of age, it is thought to be caused by in the balance of the normal estrogen to progesterone ratio
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Q
What are the two main features of FBC and what are the symptoms?
A
Fibrosis and cysts. Areas of fibrosis are made up of fibrous connective tissue and are firm or hard. Cysts are spaces filled with fluid line by breast glandular cells. Typical symptoms include breast pain and tender lumps or areas of thickening in the breasts. The lumps are rubbery, ill-defined, and commonly found in the upper outer quadrant of the breast.
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What type of women may develop FBC OR experience worsening of symptoms
Postmenopausal women taking hormone replacement therapy
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Management of FBC focuses on the symptoms of the condition. what are some nursing considerations for the patient that has FBC.
use of mild analgesics such as ibuprofen or limiting salt intake before menses to help decrease swelling. Wearing a supportive bra can reduce pain by decreasing tension on the ligaments and local application of ice or heat may provide temporary relief.
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What are the drug therapies for FBC if indicated.
Oral contraceptives may be prescribed it to suppress oversecretion of estrogen, and progestins used to correct luteal insufficiency. Treatment for FBC may also include the use of vitamins C, E, and B complex. Diuretics maybe prescribed to decrease menstrual breast engorgement.
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What are the risks associated with drug therapy for FBC.
Stroke, liver disease, increased intracranial pressure. Seek medical attention immediately if any signs or symptoms of these complications occur.
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What is ductal ectasia
Is it benign breast problem that is usually seen in women approaching menopause. It occurs when a breast duct dilates and it's walls thicken, causing the duct to become blocked. The ducts in the subareolar area Are most often affected. These ducts become distended and filled with cellular debris, which activates an inflammatory response.
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What are the manifestations that result from ductal ectasia
A mass develops that feels hard, has irregular borders, and maybe tender.
A greenish brown nipple discharge, enlarged axillary node's, and redness and edema over the site of the mass are noted
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Evaluation/Nursing care for patients with duct ectasia are?
Mammogram, a microscopic examination of the nipple discharge is performed to detect a typical or malignant cells and the affected area is excised. Nursing care is directed at reducing the anxiety associated with the threat of breast cancer and at supporting the women through diagnostic and treatment procedures. It may improve without treatment. Warm compress and antibiotics maybe helpful. If symptoms do not improve, the abnormal duct may be surgically removed
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Factors that put at high increased risk for breast cancer are what? What is the primary risk factor?
Female gender (99% of all breast cancer is occurred women), Age above 50 years ( greatest risk for women his age is 50 to 69 years), genetic factors( inherited mutations of BRCA1 and or BRCA2 increase risk), Family history, history of previous breast cancer, breast density( dense breasts contain more glandular and connective tissue, which increase risk for developing breast cancer.). Being an older woman.
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What are manifestations of breast cancer
Breast pain, tenderness, swelling, fixed, and hard mass with irregular borders, dimpling, nipple inversion, change in breast size or shape. Another sign, sometimes indicating late stage breast cancer, is an edematous thickening and pitting of breast skin called Peau d'orange (orange peel skin).
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How do you stage tumors
TNM: tumor, nodes, metastasis
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The most common sites of metastatic disease for breast cancer
Bone, lungs, brain, and liver
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What are the two broad categories of breast cancer and which one occurs more often?
Invasive and noninvasive. About 20% are noninvasive and 80% invasive.
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What does noninvasive invasive breast cancer mean
As long as the cancer remains within the duct, it is not invasive. The cancer is classified as invasive penetrates the tissue surrounding the duct. Metastasis occurs when cancer cells leave the breast via the blood and lymph systems, which permits spread of these cells to distant sites.
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What are some noninvasive breast cancers
Ductile carcinoma in situ and lobular carcinoma in situ.
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What is ductal carcinoma in situ
Cancer cells are located within the duct and have not invaded the surrounding fatty breast tissue. It is important to remember that although DCIS should be treated to prevent it from developing into an invasive breast cancer, it does not metastasize at this stage.
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What are some invasive breast cancers
Infiltrating ductal carcinoma and inflammatory breast cancer
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What is infiltrating ductal carcinoma
As the name implies, the disease originates in the mammary ducts and grows in the epithelial cells lining these ducts. Once invasive, the cancer grows into the tissue around it and in a irregular pattern. If a lump is present, it is felt as an irregular, poorly defined mass. As a tumor continues to grow fibrosis(replacement of normal cells with connective tissue and college ) develops around the cancer.
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What can fibrosis cause in invasive breast cancers
May cause shortening of Cooper's ligaments and the resulting typical skin dimpling that is seen with more advanced disease.
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What are medical and surgical treatments for breast cancer
Radiation and chemo therapy, modified radical mastectomy and/simple mastectomy, breast conserving surgery (lumpectomy), hormonal therapy, reconstructive surgery, prosthetics, rehab
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What is a major source of estrogen in the body after ovaries stop functioning.
Fat tissue. Having a greater amount of fat tissue increases hormonal influence on breast cancer development
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What does Nulliparity mean
No pregnancies
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What are low increased risk factors for breast cancer
Nulliparity, first child born after age 30, menstrual history(early menstruation or late menopause, or both), oral contraceptives ( there is a slight increase in breast cancer risk and women taking oral contraceptives), hormone replacement therapy ( use of estrogen and progestin increases risk; routine use of hormone therapy for osteoporosis and heart disease is no longer recommended). And obesity.
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What are other risk factors for breast cancer
Alcohol(risk is dose-dependent; consumption of 3 to 14 drinks per week is associated with a slight increase in risk; risk increases with increased consumption), jewish heritage( Women of Ashkenazi Jewish heritage have higher incidences of BRCA1 and BRCA2 genetic mutations)
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What should you teach the patient before breast augmentation surgery
Teach the patient to stop smoking (to promote healing) aspirin and other NSAIDs and avoid herbs that can cause bleeding during procedure, such as garlic, ginkgo and ginseng.
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What should you remind the patient after breast augmentation of?
That for the first few days she should expect soreness in her chest and arms. Her breasts will feel tight and sensitive, and the skin over the breast may feel warm or may itch. Teach the patient that she will have difficulty raising her arms over her head and should not lift, push, or pull anything until the surgeon permits. Teach her to also avoid strenuous activity or twisting above her waist. Reminded patient to walk every few hours to prevent deep vein thrombi. Tell her to expect some swelling of the breasts for 3 to 4 weeks after surgery.
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What is lymphedema
And abnormal accumulation of protein fluid in the subcutaneous tissue of the affected limb after Mastectomy.
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What are risk factors to lymphedema
Injury or infection of the extremity, obesity, presence of extensive axillary disease, and radiation treatment
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What information do you need to provide with the patient that has lymphedema
Teach the importance of avoiding having blood pressure measurements taken on, having injections in, or having blood drawn from the arm on the side of the nicer to me. If lymphedema occurs, early interventions provides the best chance for control. The arm should be elevated when possible especially attention paid to the special precautions. The patient will be fitted for a compression sleeve and or glove, to be taught exercises and manual lymph drainage. Management is directed toward measures that promote drainage of the affected arm. Teach patients, especially those who have had axillary lymph nodes removed, that measures to prevent lymphedema are lifelong and include avoiding trauma to the arm on the side of the mastectomy.
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What are some protective factors against breast cancer
Pregnancy before the age of 30, breast-feeding, exercise
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What is vulvovaginitis
Is inflammation of the lower genital tract resulting from a disturbance of the balance of hormones and flora in the vagina and vulva.
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Vulvovaginitis maybe characterized by what
Itching, changing vaginal discharge, odor, or lesions.
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What is most common causes of vulvovaginitis
Fungal (yeast) infections (candida albicans), bacterial vaginosis, STDs( trichomonas vaginalis), postmenopausal vaginal atrophy, changes in the normal flora or pH (from douching) , Chemical irritants or allergens( vaginal spray, fabric dyes, detergent) or foreign body (tampon), drugs(especially antibiotics), immunosuppression from diabetes or HIV.
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We are probably infections that affect the Vulva
Herpes genitalis and condylomata acuminata (human papilloma virus, venereal warts)
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What are secondary infections of the Vulva
Caused by organisms responsible for many types of vaginitis, including candidiasis. Pediculosis pubis(crab lice) and scabies ( itch mite) are common parasitic infestations of the skin of the vulva.
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What is the itch scratch itch cycle that some women may have with vulvovaginitis.
The itching leads to scratching, which causes excoriation that then must heal. As healing takes place itching occurs again. If the cycle is not interrupted, the chronic scratching may lead to the white, thicken skin of lichen planus. This dry, leathery skin cracks easily increasing the women's risk for infection
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What is lichen planus
Lichen planus (LIE-kun PLAY-nus) is an inflammatory condition that can affect your skin and mucous membranes.
On the skin, lichen planus usually appears as purplish, often itchy, flat-topped bumps. In your mouth, vagina and other areas covered by a mucous membrane, lichen planus forms lacy white patches, sometimes with painful sores.
Lichen planus occurs when your immune system mistakenly attacks cells of the skin or mucous membranes. The reason for this abnormal immune response is unknown. You can't catch lichen planus or give it to another person. Most people can manage typical, mild cases of lichen planus at home, without prescribed medical treatment. If the condition causes pain or significant itching, you may need medication to suppress your immune system.
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Nursing interventions to relieve itching from vulvovaginitis include
Applying wet compress, sitz bath for 30 minutes several times a day, using topical drugs such as estrogens and lidocaine. Encourage the removal of any irritant or Allergen, such as changing detergents
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How to prevent vulvovaginitis
Where cotton underwear, avoid wearing tight clothing such as pantyhose or tights jeans because they can cause chasing. You can also get hot and sweaty, which can cause infection. Always wipe front to back after how about movement or urinating. During bath shower, Wash inner labial mucosa with water, not soap. Do you not douche or use feminine hygiene sprays.
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What is treatment for pediculosis and scabies.
Applying Lindane (kwell, kwellada) lotion, shampoo, or cream to the affected area as directed. Cleaning affected clothes, bedding, and towels. Disinfecting the home environment (live cannot live for more than 24 hours away from the body)
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Is the cause vulvovaginal candidiasis
The cause is believed to be related to the change in vaginal pH that allows accelerated growth of the yeast fungal infection.
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What are some conditions that result in changes and vaginal pH of floor that favor accelerated growth of vulvovaginitis (C. Albicans)
Pregnancy, diabetes mellitus, oral contraceptive use, and systemic antibiotic therapy.
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What are the main symptoms of Volvovaginal candidiasis
Vaginal and perineal itching. Vulvar and vaginal tissues are inflamed, causing burning on urination. Vaginal discharge is white with a typical cottage cheese appearance. Diagnosis is made by identifying the spores of C.albicans.
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What is a pat smear
Is a cytologic study that is effective and detecting precancerous and cancer cells, inflammation, infections, and dysplasia from the cervix and is done immediately before the pelvic examination.
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When should Pap test be scheduled and what should you teach the patient prior to the test.
The Pap test should be scheduled between the woman's menstrual periods so that the menstrual flow does not interfere with the test interpretation. Teach women not to douche, use vaginal medications or do you deodorants or have sexual intercourse for at least 24 hours before the test
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What is the Bethesda system.
Describe standard terminology for results of both the conventional Pap test and the liquid preparation.
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What are the three elements of the Bethesda the system.
A statement of specimen adequacy, a general category for analysis normal or abnormal, and a descriptive diagnosis for normal or abnormal cytology whether results suggest malignancy or another disorder.
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What are the bethesda classifications
Atypical squamous cells of underdetermined significance (ASCUS)
Squamous intraepithelial lesion which is subdivided into (a) low-grade or LSIL (including cellular changes of HPV) and (b) hi grade, or HSIL ( previously categorized as carcinoma in situ) HSIL is more likely to become cancerous without definitive treatment.
Atypical glandular cells of uncertain significance(AGCUS)
Adenocarcinoma
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What is the follow up for paps smear depend on.
On the nature of the Adam Audi and whether it is persistent. Pap tests that have persistent abnormal findings such as with mild inflammation and or atypical squamous cells are usually repeated 3 to 6 month intervals usually and all questionable PAP are evaluated by a colposcopy, and biopsy is done for suspicious lesions.
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What is a colposcopy
Examination of vaginal and cervical tissue with a colposcope for cell magnification. Is application of a 3% acetic acid solution onto the cervix to see abnormalities that can't be seen with the naked eye, feels like getting a Pap test, but lasts longer. if abnormal tissue was recognized, multiple biopsies of the cervical tissue are performed. Tell patient that she'll have drainage up for two weeks. Teach patient to notify healthcare provider if discharge is worse or there is more pain
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Human papilloma virus test
Can identify many high-risk types of HPV associated with the development of cervical cancer. This test can be done at the same time as the Pap test for women older than 30 years and for women of any age who have had an abnormal Pap test results.
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Can the HPV test take place of the Pap test
No it does not take place of the Pap test because it tests for the viruses that can cause cell changes in the cervix that, if not treated, can lead to cancer.
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What symptoms of cervical cancer you should ask.
Ask the woman if she has a watery blood tinged vaginal discharge it becomes dark and Foul smelling ( occurs as the disease progresses). Unusual vaginal discharge. Bleeding with intercourse, between periods, or after menopause. Leg pain(along the sciatic nerve) or swelling of one leg may be a late symptom of hydronephrosis, indicating advanced cancer pressing on the uterus, backing up the urine into the kidneys.
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What is the classic symptom of invasive cervical cancer?
Painless vaginal bleeding
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What is a endocervical curettage
Scraping of the endocervix wall if atypical granular cells are suspected.
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What is the care after local cervical ablation therapies?
Refrain from sexual intercourse, do not use tampons, do not douche, take showers rather than tub baths, avoid lifting heavy objects, report any heavy vaginal bleeding, foul-smelling drainage, or fever. The usual time for these restrictions is three weeks. Your healthcare provider may prescribe a different longer or shorter timeframe for you.
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Early-stage 1 management techniques of cervical cancer include what
Ablation therapies of electrosurgical excision, laser therapy, or cryosurgery
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What is loop electrosurgical excision procedure?
A thin loop wire electrode that transmits a painless electrical current is used to cut away affected tissue from the cervix. LEEP is both a diagnostic procedure andtreatment, because it provides a specimen that can be examined by a pathologist to ensure the lesion was completely removed
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What is laser ablation therapy
Elizabeth was directed to the ad normal tissues of the cervix where energy from the beam is absorbed by the fluid in the tissues causing them to vaporize. Healing occurs 6-12 weeks.
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What is cryotherapy
Involves freezing of the cervical tissue resulting into tissue destruction and necrosis.
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What should you tell the patient what they'll experience after cryotherapy
The procedure is often painless, although some women have slight cramping after the procedure. The patient has a heavy watery discharge for several weeks after the procedure.
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In cases of microinvasive cancer, what procedure is used to still preserve fertility.
Conization. This procedure is done when the lesion cannot be visualized by colposcope. A cone shaped area of cervix is removed surgically and sent to the laboratory to determine the extent of the cancer
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What is radical trachelectomy
Fertility preserving option for young woman with early-stage disease, surgical removal of the cervix, upper vagina and surrounding tissues, lymph nodes are removed, the body of the uterus and ovaries are not removed. It is stitched up and the patient will have a C-section to give birth
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What is endometrial cancer, what's the most common type, and what are the four stages.
Cancer of the inner uterine lining. Adenocarcinoma. Stage one endometrial cancer is confined to the endometrium. Stage 2 cancer also involves the cervix, and stage III reaches the vagina or lymph nodes. Stage 4 cancer has spread beyond the pelvis.
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How does metastasis outside the uterus occur in endometrial cancer
Through lymphatic spread to the ovaries and parametrial, pelvic, and inguinal, and para-aortic lymph nodes. By blood, to the lungs, liver, or bone. By transtubal or intra-abdominal spread to the peritoneal cavity
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What's the cause of endometrial cancer
Endometrial cancer is strongly associated with conditions causing prolonged exposure to estrogen without the protective effects of progesterone.
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What are some risk factors for endometrial cancer
Women in reproductive years, family history of endometrial cancer, diabetes mellitus, hypertension, obesity, uterine polyps, late menopause, Nulliparity, smoking, tamoxifen (given for breast cancer)
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What is the main symptom of endometrial cancer
Postmenopausal bleeding.
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The symptoms may indicate what type of cancer. Some women have a watery, bloody vaginal discharge, low back or abdominal pain, and low pelvic pain (caused by pressure of the enlarged tumor). The pelvic exam may reveal the presence of a palpable uterine mass or uterine polyp. The uterus is enlarged if the cancer is advanced.
Endometrial cancer
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What is the gold standard tests to determine the presence of endometrial thickening and cancer
Transvaginal ultrasound and endometrial biopsy
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Ascites is a symptom of what type of gynecologic cancer and why?
Ovarian. Free-floating cancer cells also spread through the abdomen to seed new sites.
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What type of cancer seems to be a disordered growth in response to excessive exposure to estrogen and explain the protective effects of pregnancies and contraceptive use, both of which interrupt the monthly estrogen exposures.
Ovarian.
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What a risk factors for ovarian cancer
Older than forty years, family history of ovarian or breast cancer, diabetes mellitus, Nulliparity older than 30 years at first pregnancy, breast cancer, colorectal cancer, infertility, BRCA1 or BRCA2 gene mutation, early menarche/late menopause, endometriosis, obesity/high fat diet.
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Most women with ovarian cancer have mild symptoms for several months but may have thought that they were due to normal perimenipausal changes or stress. what are some of the symptoms that the patient may report
Abdominal pain or swelling or have big G.I. disturbances such as dyspepsia and gas (bloating).Ask the patient if she has had urinary frequency or incontinence, unexpected weight loss and or vaginal bleeding. Ovarian cancer symptoms are persistent and represent a change for normal, ovarian cancer symptoms are typically present almost daily for more than a few weeks
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What are some complications of advanced metastatic ovarian cancer include
Pleural effusion, ascites, lymphedema, intestinal obstruction, malnutrition.
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Could you use Pap smear to detect ovarian cancer?
A Pap smear is of limited value for detecting a very and cancer
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What are the 2 types of ovarian cysts?
Maybe either follicular or luteal. If the ovarian follicle cells fails to rupture during ovulation, a follicular cyst may develop. The cysts are usually asymptomatic, and they usually progress during the next menstrual cycle. A lutein cyst may develop if the corpus lutein becomes cystic and fails to regress. A lutein cyst is my likely to cause pain and some delay in the next menstrual cycle. Occasionally an ovarian cyst can rupture and twist on it pedicle and come infarcted, causing pelvic pain and tenderness
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This is a rare condition and it is a potentially fatal condition caused by toxin producing strains of staphylococcus aureus. The toxin produced alters capillary permeability, which allows intravascular fluid to leak from the blood vessels, leading to hypovolemia, hypotension, and shock. The toxin also causes direct tissue damage to organs and precipitates serious defects in coagulation.
Toxic Shock Syndrome
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What are some factors that are linked to having toxic shock syndrome
Exotoxins produced from the bacteria cross the vaginal mucosa to the bloodstream via microabrasions from tampon insertion or prolonged use. Use of tampons or barrier contraceptives for A prolonged time may trap and hold bacteria that can grow.
Other conditions associated with toxic shock syndrome include surgical wound infection nonsurgical infections, and gynecologic surgeries.
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Where the signs and symptoms of toxic shock syndrome
Fever temperature above 102 F
Diffuse rash resembling sunburn with broken capillaries in eyes and skin.
Peeling of the skin, primarily the soles of the feet and the palms of the hands, 1 to 2 weeks after onset of the illness
Hypotension, systolic blood pressure below 90 or orthostatic syncope
Involvement of three or more of these symptoms: G.I. system: vomiting, diarrhea at the onset of the syndrome.
Musculoskeletal system: severe aching or a serum creatinine phosphatase level twice the normal level.
Respiratory system: ARDS
Renal/urinary system: decreased urine output it, pyuria
Cardiovascular system: decreased left ventricular contractility; ischemic changes shown on the EKG.
liver: Jaundice DIC
Hematologic system: platelet levels below normal
Central nervous system: disorientation, altered consciousness in the absence of fever or hypertension
Mucous membranes: hyperemia the vaginal walls, the throat, or the conjunctiva of the eye.
Negative results for Rocky Mountain spotted fever, measles and scarlet fever and for throat, blood and Siri will spinal fluid cultures
Positive culture for staphylococus aureus from blood, urine or stool.
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What information does the nurse provide to help prevent TSS.
For tampon use: wash the hands thoroughly to remove bacteria before inserting tampons, change tampons at least every four hours to prevent excessive bacterial growth on the tampon, do not use superabsorbent tampons at any time because they may be left in the vagina for a prolonged period, allowing bacteria to proliferate, use pads rather than tampons during hours of sleep, which usually exceed the four hour segments of tampon use.
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What is a cystocele
When the weekend upper anterior wall of the vagina is a longer able to support the weight of urine in the bladder, cystocele develops. The bladder protrudes downward into the vagina resulting in incomplete emptying of the bladder and consequent cystitis.
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What are the signs and symptoms of Cystocele?
Patient feeling as if something is falling out, dyspareunia, backache and a feeling of heaviness or pressure in the pelvis. Difficulty in emptying the bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence(Loss of urine during activities that increase intra-abdominal pressure such as laughing, coughing, sneezing, or lifting heavy objects)
Symptoms become worse after prolonged standing and I relieved by lying down.
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What are some nursing considerations for the patient that has cystocele
Teach woman to improve pelvic support and tone via pelvic floor muscle exercises aka kegal exercises. Space feeling devices such as pessaries or Spheres can be worn in the vagina to elevate the uterine prolapse. Intravaginal estrogen therapy maybe prescribed for the postmenopausal women to prevent atrophy and weakening of the vaginal walls. Women with bladder symptoms may benefit from bladder training and attention to complete emptying.
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What is enterocele
Refers to prolapse of the upper posterior vaginal wall between vagina and rectum. This condition is almost always associated with herniation of the pouch of Douglas, a fold of peritoneum that dips down between the rectum and uterus, and may contain loops of bowel.
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What is rectocele
It occurs when the posterior wall of the vagina becomes weakened and thin. When the woman strains at defecation, feces or pushed against the thinwall, causing further stretching, until finally the rectum protrudes into the vagina. Many rectocele are small and produce few symptoms. If large enough, the woman may have difficultly emptying the rectum.
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What are the signs and symptoms of rectocele and enterocele?
Constipation, hemorrhoids, fecal impaction, and feelings of rectal or vaginal fullness. A vaginal and rectal examination may show a bulge of the posterior vaginal wall when the woman is asked to bear down.
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What is the management for the patient who has rectocele
Focus on promoting validation. The healthcare provider usually prescribes a high-fiber diet, stool softener, and laxatives
